The use of comorbidities among adults experiencing care transitions: a systematic review and evolutionary analysis of empirical literature

Objective: To systematically review how comorbidities are employed in the empirical literature for adults coping with multiple chronic conditions during common episodes of acute illness that resulted in transition across health care setting. Methods: Evolutionary concept analysis inductively identifies current consensus regarding the usage of a concept and results in exploring attributes and clarification of the concept. Sixty studies from 1965 to 2009 identified from MEDLINE, CINAHL, PsychINFO, and ISI Web of Science databases were analysed. Results: Comorbidities were used heterogeneously among reviewed studies with most controlling for their presence (n=33) and lacking robust measurement (n=37). The designation of index or principal condition was equally heterogeneous with approximately half (n=26) representing the main disease or diagnosis of interest to the researcher. In this study comorbidities were associated with personal, disease or system level antecedents and consequences. A conceptual framework is proposed. Discussion: The impact of comorbidities on the care and outcomes of adults coping with multiple chronic conditions is limited by heterogeneous and ambiguous usage. While analytic techniques have become more sophisticated, continued lack of meaningful conceptualization and instrument use has limited maturation of this important concept for research, practice and policy purposes.

[1]  Harleah G. Buck,et al.  A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions. , 2011, Journal of cardiac failure.

[2]  Caroline Sanders,et al.  Shifting priorities in multimorbidity: a longitudinal qualitative study of patient’s prioritization of multiple conditions , 2011, Chronic illness.

[3]  D. Scharfstein,et al.  Caregiving and chronic care: the guided care program for families and friends. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[4]  G. Fonarow,et al.  Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. , 2009, The American journal of medicine.

[5]  M. Lage,et al.  The relationship between antipsychotic medication adherence and patient outcomes among individuals diagnosed with bipolar disorder: a retrospective study , 2009, Annals of general psychiatry.

[6]  L. Shaw,et al.  Depression and cardiovascular health care costs among women with suspected myocardial ischemia: prospective results from the WISE (Women's Ischemia Syndrome Evaluation) Study. , 2009, Journal of the American College of Cardiology.

[7]  I. Miller,et al.  Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. , 2008, Clinical psychology review.

[8]  D. Mannino,et al.  Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD , 2008, European Respiratory Journal.

[9]  Mary Naylor,et al.  Transitional Care , 2008, The American journal of nursing.

[10]  P. Decker,et al.  Obesity as a risk factor for unanticipated admissions after ambulatory surgery. , 2008, Mayo Clinic proceedings.

[11]  Chad Boult,et al.  Early effects of "Guided Care" on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  D. Bradham,et al.  A national perspective of Medicare expenditures for elderly veterans with hip fractures. , 2008, Journal of the American Medical Directors Association.

[13]  T. Zyczynski,et al.  Resource utilisation, charges and mortality following hospital inpatient admission for congestive heart failure among the elderly in the US , 2008, Journal of medical economics.

[14]  Wanzhu Tu,et al.  Geriatric care management for low-income seniors: a randomized controlled trial. , 2007, JAMA.

[15]  J. Kogan,et al.  Predictors of timely follow-up care among medicaid-enrolled adults after psychiatric hospitalization. , 2007, Psychiatric services.

[16]  David O. Williams,et al.  Comparison of outcome in patients with ST-elevation versus non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry). , 2007, The American journal of cardiology.

[17]  L. Neumayer,et al.  Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: general surgical operations in men. , 2007, Journal of the American College of Surgeons.

[18]  H. Cohen,et al.  Report of the national institute on aging task force on comorbidity. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  L. Ferrucci,et al.  Comorbidity : The Ultimate Geriatric Syndrome Review Article Methodology , Design , and Analytic Techniques to Address Measurement of Comorbid Disease , 2007 .

[20]  Gerry Richardson,et al.  The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial , 2007, Journal of Epidemiology and Community Health.

[21]  Latanya Sweeney,et al.  Patient-centered management of complex patients can reduce costs without shortening life. , 2007, The American journal of managed care.

[22]  Luigi Ferrucci,et al.  Frailty: an emerging research and clinical paradigm--issues and controversies. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[23]  A. Sakr,et al.  Nesiritide in the initial management of acute decompensated congestive heart failure. , 2006, Connecticut medicine.

[24]  Marian W. Roman.  THE PROCESS OF RECOVERY: A TALE OF TWO MEN , 2006, Issues in mental health nursing.

[25]  Eric Peterson,et al.  Diabetes status and racial differences in post-myocardial infarction mortality. , 2005, American heart journal.

[26]  D. Moser,et al.  Vulnerabilities of patients recovering from an exacerbation of chronic heart failure. , 2005, American heart journal.

[27]  R. Habib,et al.  Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association. , 2005, Journal of the American College of Cardiology.

[28]  S. Gabriel,et al.  Direct medical costs of polymyalgia rheumatica. , 2005, Arthritis and rheumatism.

[29]  A. Nissenson,et al.  Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[30]  R. Pitman,et al.  Reevaluating the association between emergency department heart rate and the development of posttraumatic stress disorder: A public health approach , 2005, Biological Psychiatry.

[31]  E. Vittinghoff,et al.  Predictors of Heart Failure Among Women With Coronary Disease , 2004, Circulation.

[32]  K. Johansen,et al.  Association of body size with outcomes among patients beginning dialysis. , 2004, The American journal of clinical nutrition.

[33]  M. Naylor,et al.  Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial , 2004, Journal of the American Geriatrics Society.

[34]  J. Strain,et al.  Congestive heart failure and depression in older adults: clinical course and health services use 6 months after hospitalization. , 2003, Psychosomatics.

[35]  John F. Steiner,et al.  Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases , 2003, The Annals of Family Medicine.

[36]  G. Reiber,et al.  Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. , 2003, Diabetes care.

[37]  Shin-Ping Tu,et al.  Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseases. , 2002, Chest.

[38]  F. Dominici,et al.  Asthma in older patients: factors associated with hospitalization. , 2002, Archives of internal medicine.

[39]  W. Satariano,et al.  Causes and consequences of comorbidity: a review. , 2001, Journal of clinical epidemiology.

[40]  R. Morrison,et al.  Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[41]  Eun-Ok Im,et al.  Experiencing Transitions: An Emerging Middle-Range Theory , 2000, ANS. Advances in nursing science.

[42]  J. Zuckerman,et al.  Effect of previous cerebrovascular accident on outcome after hip fracture. , 2000, Journal of orthopaedic trauma.

[43]  M. Naylor.  A decade of transitional care research with vulnerable elders. , 2000, The Journal of cardiovascular nursing.

[44]  W. Weaver,et al.  Early angiography versus conservative treatment in patients with non-ST elevation acute myocardial infarction: MITI Investigators. Myocardial Infarction Triage and Intervention. , 2000, Journal of the American College of Cardiology.

[45]  B. Jonathan.  Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial , 1999 .

[46]  P. Friedmann,et al.  Older patients' health-related quality of life around an episode of emergency illness. , 1999, Annals of emergency medicine.

[47]  J. Avorn,et al.  Aging, comorbidity, and reduced rates of drug treatment for diabetes mellitus. , 1999, Journal of clinical epidemiology.

[48]  G. Arana,et al.  Alcohol dependence and hospitalization in schizophrenia , 1999, Schizophrenia Research.

[49]  D. Armstrong,et al.  Risk Factors for Above‐Knee Amputations in Diabetes Mellitus , 1998, Southern medical journal.

[50]  R. Havlik,et al.  Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients , 1998, Cancer.

[51]  D. Armstrong,et al.  Institutionalization following diabetes-related lower extremity amputation. , 1997, The American journal of medicine.

[52]  M. Naylor,et al.  Factors Contributing to Rehospitalization of Elderly Patients with Heart Failure , 1997, The Journal of cardiovascular nursing.

[53]  F. Gottschalk,et al.  Pre and post-amputation mobility of trans-tibial amputees: Correlation to medical problems, age and mortality , 1995, Prosthetics and orthotics international.

[54]  K. Schumacher,et al.  Transitions: a central concept in nursing. , 1994, Image--the journal of nursing scholarship.

[55]  Victoria Neufeldt,et al.  Webster's New World Dictionary of American English , 1988 .

[56]  A. Feinstein,et al.  The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. , 1974, Journal of chronic diseases.

[57]  A R Feinstein,et al.  THE PRE-THERAPEUTIC CLASSIFICATION OF CO-MORBIDITY IN CHRONIC DISEASE. , 1970, Journal of chronic diseases.

[58]  A. Meléis,et al.  Transitions theory : middle-range and situation-specific theories in nursing research and practice , 2010 .

[59]  J. Cramer,et al.  Psychiatric disease burden profiles among veterans with epilepsy: the association with health services utilization. , 2008, Psychiatric services.

[60]  W. Henderson,et al.  Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: vascular surgical operations in women. , 2007, Journal of the American College of Surgeons.

[61]  A. Sonnenberg,et al.  Epidemiology of Clostridium difficile Infection in a Large Population of Hospitalized US Military Veterans , 2004, Digestive Diseases and Sciences.

[62]  David M. Adamson,et al.  Living Well at the End of Life: Adapting Health Care to Serious Chronic Illness in Old Age , 2003 .

[63]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.